An evaluation of Actilite - Antibacterial non-adherent dressing with Activon Plus: Case study 4

This study was undertaken by Jivka Dimitrova - Tissue Viability Specialist Nurse. The University Hospitals of Leicester NHS Trust

Case study 4

Male diabetic patient with leg ulceration

A 74 year old male with a thirteen year history of type 2 diabetes mellitus visited out-patients diabetic foot clinic. He also has a seven year history of Charcot joint to his right foot. His diabetes is controlled with insulin.

On examination he had two areas of ulceration to plantar and dorsal aspect of right foot. He was admitted as an inpatient for debridement of wounds by orthopaedic surgeons. Following debridement the ulcers appeared infected with surrounding cellulitis. Patient continued to attend foot clinic on a weekly basis where the wounds were reviewed by tissue viability and the use of Actilite was recommended. He was also treated with Doxycycline. The ward followed the same regime, resulting in a dressing change every three days. On discharge, the wound remained clean, granulation tissue had started to form around wound margins and the cellulitis had subsided. Two months later the gentleman returned to foot clinic, having visited his local trauma clinic for dressing changes in the interim. On examination the wound to the plantar aspect appeared to be larger in size, surrounding skin was macerated and some slough was noted to the wound bed. The patient reporting that a hydrofibre dressing had been used but this was not suiting him. The wound was sharp debrided by podiatrist back to healthy tissue. Due to the increased risk of recurrent infections in patients with diabetic foot ulcers and the resulting implications on healing, Actilite was reapplied for its antimicrobial properties. It was also the preference of the patient as he felt that no other dressing had been as effective. He was sent home with Actilite dressings and a letter for the district nurses to continue to change dressing every three days. Two weeks later at follow up in foot clinic, the wound remained clean and granulating with evidence of healing and no evidence of infection or inflammation.